Caspar Wistar



In early September when Dr. Benjamin Rush first tried drastic purges on patients, he invited Dr. Caspar Wistar to observe their affects on the wife of Captain Bethel, a ship's chandler on North Front Street. She was Rush's mother's step-daughter from her last marriage. She was experiencing the restlessness characteristic of the early stages of the fever. Rush told her to "drink copiously of chicken water," i.e. a very weak broth, and lie in her bed. Then he gave her a pill that combined 10 grains of calomel with 15 grains of rhubarb. She took the first dose, and the two doctors did not have long to wait for a reaction. She vomited "a large quantity of bile."

Wistar was taken aback by the violence of the reaction, and asked, "whether it gave relief as an emetic or cathartic?" That is, was it intended to induce vomiting or purge the intestines and bowels. Rush answered that while the target was not the stomach, but the seat of putrefaction below, the puking was a good sign showing that the medicine provided "more speedy service." Wistar argued that if relief came from vomiting, a medicine with less bothersome side effects could have been used. Rush ended the discussion by giving Mrs. Bethel another dose. Wistar thought Mrs. Bethel looked "very unwell." Rush later told Wistar that he waited until the pill brought on a copious purge followed by a sweat, and Mrs. Bethel recovered.

Wistar soon found it more difficult to see patients. He had constant headaches. Then he could no longer stand the light of the sun. He diagnosed his own case: he had yellow fever. He had taken preventatives, including bark every morning and evening,

and followed all the rules save one - he swallowed his spittle while in a sick room. Because of that Wistar thought he got the fever. Two days after he saw Rush treat Mrs. Bethel, he had "a smart fever and delirium." By a messenger Rush ordered him to take calomel, but he didn't. He had his apprentice fetch ipecac, which worked several times.

His stomach still felt heavy and sore. Then Rush came to him and did not consult. He insisted that Wistar take calomel and jalap. He did and when he was able, Wistar sent word that the purge operated and relieved him, but he didn't tell Rush that his fever returned sharply and he felt miserable.

When Wistar recovered, Rush counted it a major victory for mercurial purges. He tried to elicit a testimonial for his cure. For the moment Wistar kept to himself what remedies he thought most beneficial. He appreciated the power of calomel, but as he recovered from a delirium he became conscious of a wonderful cold wind from a window left open in his room. He instructed his students to keep him cool. When the breeze from the window was too hot, the young men took turns fanning their master. To that, Wistar attributed his recovery.

A few weeks later Wistar described his illness and treatment in a letter published in a newspaper. After describing his consultations with Rush early in his illness, and how calomel and jalap relieved him, Wistar said he was not sure if mercurials or milder saline cathartics were better. That said, he endorsed cold air as the best remedy. Having the window open had revived him far more than any medicine. Wistar also acknowledged Dr. Kuhn for stopping his diarrhea with laudanum, and prescribing a "tincture amara" which, after sipping for every two hours for 24 hours, allowed Wistar to "eat rice and chocolate without suffering."

After reading that Rush threw down the paper, and quoted Shakespeare's Julius Caesar: "This was the most unkindly cut of all...." Wistar was his Brutus. He lashed out at Wistar in his morning letter to his wife. Wistar's letter was "certainly calculated to injure me and to create doubts as to the efficacy of the new remedies."

He wrote a short letter to the newspaper chiding Wistar. If he had taken calomel as Rush had prescribed it, he would have recovered quickly and been back at work, "uniting at the same time, his testimony, with that of thousands of his fellow citizens, in favor of that excellent remedy."

George Washington and Yellow Fever

In 1793 there were neither policies nor precedents about how the federal government should react to a deadly epidemic in the nation's capital. Government officials and employees did not work in offices set apart from the rest of the city. The President lived in a rented mansion flanked on one side by a shady garden, but he had neighbors though it was in a more thinly built part of the city. In the first week of September one of his neighbors, Dr. Caspar Wistar, was sick with yellow fever.

Well before the epidemic, George Washington planned to leave the city. High Federal officials generally left the capital in September. Congress was not in session and it was a good chance to relax before Congress assembled in November or December. In 1793 Washington was expected to attend the ceremonial laying of the cornerstone of the new Capitol building in the new City of Washington, scheduled for September 17. The painting below, done in the 1790s, arranged Washington's family around the plan for the new capital city and captured the President's interest in the city that would bear his name.



Treasury Secretary of Alexander Hamilton was unable to attend a cabinet meeting on September 6, sending word that both he and his wife had yellow fever. The death of Dr. Hutchinson on September 7, while good news for the President as the doctor was a leader of the opposition party that had been personally attacking the President, his death undoubtedly colored the President's view of the health of the city.

On September 9, on the eve of his scheduled departure, the President wrote to Secretary of War Knox about a rumor about French intentions, adding:

I think it would not be prudent either for you or the Clerks in your Office, or the Office itself to be too much exposed to the malignant fever, which by well authenticated report, is spreading through the City; The means to avoid it your own judgment under existing circumstances must dictate.
( Washington to Knox )

It is a fair interpretation of this letter to suggest that Washington was anxious to leave and thought the best policy for the Federal government to follow was for all unessential employees to leave the city. At that time the Federal government had no means to respond to the epidemic. It did not employ any doctors, nurses, or anyone else in or near Philadelphia who could respond in an official capacity to the epidemic. There were no soldiers stationed in the city, nor was there a Federal police force of any kind.

Washington left the city with his wife, family and servants on September 10. In a September 25 letter to his secretary Tobias Lear, written from Mount Vernon, he described what he was thinking when he left:

We remained in Philadelphia until the 10th. instr. It was my wish to have continued there longer; but as Mrs. Washington was unwilling to leave me surrounded by the malignant fever wch. prevailed, I could not think of hazarding her and the Children any longer by my continuance in the City the house in which we lived being, in a manner blocaded, by the disorder and was becoming every day more and more fatal; I therefore came off with them on the above day and arrived at this place the 14th. without encountering the least accident on the Road. ( Washington to Lear )

One could argue that on the 25th the President had put the onus for leaving on his wife, and that personally he wished to stay, mindful of the affect that might have on the morale of the afflicted city. That is a far cry from the sense of foreboding expressed in his September 9 letter which authorized the flight of Federal employees.

In writing a history of the epidemic, it is easy to forget the novelty of the situation and how that forced those living through the epidemic to not act as consistently as a historian might wish. Two things may have happened to change Washington's attitude between the 9th and 10th. Both Secretary Hamilton and Dr. Wistar responded to treatment and were thought to be out of danger. And Samuel Powel, a former mayor of city, declined Washington's invitation for his wife and he to accompany the Washington's to Mount Vernon.

Powel's wife expressed their regrets, writing to the Washington's that her husband thought he "thought there was no propriety in the citizens fleeing from the one spot where doctors were conversant with the treatment of the fever...." Powell died of the fever a little over two weeks latter. Powel





This version might be viewed as bending over backwards to burnish the image of the President, but his actions at the end of the epidemic suggest that he was indeed more mindful of the city's morale than his own safety.

In a letter to the President, Speaker of the House John Trumbull of Connecticut worried that the city would still be unsafe when Congress was scheduled to convene in December. Washington quizzed his advisers on his power to convene Congress in another place. He asked two officers still in or near the city if the suburb of Germantown was safe and if all the terrible things he had heard were true, that many "of our acquaintances have fallen victims...; that near 4000 have died, and that the disorder rages more violently than ever."

His advisers split on whether he had the power to convene Congress elsewhere. Jefferson and Madison worried that removal might jeopardize the compromise that
moved Congress from New York to Philadelphia in 1790 and would move it to the banks of the Potomac River in 1800.

As for the state of the city, Postmaster General Pickering had been going every day to Walnut Street to encourage the bedridden Dr. Rush, an act of courage given that no less an authority than Rush was certain that his house was the most infected place in the city. Pickering noticed that unlike the week before, Rush's house was no longer "thronged with applicants for assistance." Rush's two remaining apprentices, Coxe and Fisher had been joined by an old student James Woodhouse, and they continued giving out medicines and making visits for Rush. They agreed that on the 12th and 13th of October the number of applicants had "sensibly lessened." Pickering dashed off a note to the president with the encouraging news. And Germantown had to be safe. Governor Mifflin was still there.

Washington decided that, while it was still unsafe to return to Philadelphia, he could go to Germantown. He told his cabinet to rendezvous with him there on November 1.

Sickness in Philadelphia seemed to decline through October, then there was a sudden spike in cases, and a feeling of gloom returned. His cabinet advised caution. Attorney General Randolph warning that "we have not yet learned, that any radical precautions have commenced for purging the houses and furniture."

No matter. President Washington made a day trip to the city on the 11th, a day before the all clear.

Thomas Fisher

As the 1798 yellow fever epidemic spread in Philadelphia, the risks of remaining in business increasingly became apparent. A clerk in Captain Yard's store died on August 15th. A ship broker died on the 20th. By the end of the month the porter at the Bank of the United States was dead; the teller of the Bank of Pennsylvania was sick, the second teller dead. Two clerks at the Bank of the United States were missing.

The flight from the city in early August had been panic. Now most families had poignant stories to tell, too often about the deaths of promising young men and innocent boys. During previous epidemics Quakers had noted that members of their society seemed to be the last afflicted. This year they received an early lesson that one could not flee too soon. Miers Fisher removed his family on the 8th, but stayed himself until the 13th arranging the affairs of his store. His eldest son Thomas, 22 years old, also stayed preparing for a trip north. The young man had survived Baltimore's yellow fever scares, and showed his disdain for the current alarm by not being ready to leave when his father called with a carriage. After waiting two hours, the father drove off after Thomas promised to go out to an uncle's house that night. He reached his uncle's but was ill with a bad headache.

In '93 Miers had been cured by gentle French methods, and until a doctor could be found he treated his son in that manner while clinging to the hope that Thomas was having one of his usual headaches. Then Thomas had a fever. A local doctor recommended cold air and bleeding. Sixteen ounces were taken immediately and then again the next day. Thomas said he felt better but not relieved. Dr. Proudfit from the city came out and thought his case serious. He ordered blisters, and mercury internally with opium and externally to "procure a salivation."

Miers, who had been with Thomas constantly for three days, found a black nurse so he
could get some rest. The doctors came again at 6 a.m. on the 18th. The local doctor thought Thomas looked better, but not Proudfit. He ordered blisters of mercury, mercury rubs as much as the patient could take and mercury pills, at least one every two hours. Shortly after the doctors left, the father saw a spot on the bed which he suspected was black vomit. His son vomited up the next pill, throwing some of it upon his father. The father began preparing for his son's death. The doctors came again in the evening and thought there was no hope. Thomas died at five the next morning.